These Programs Do Not Typically Enroll A High Population Of Mentally Ill Inmates – Concerns For Communities And Healthcare Providers: Mental Illness And Prisoners

Now look, the United States prison system is the largest on earth.

Mentally ill individuals often find themselves in less than ideal circumstances of compounding social factors just like illicit substances and unemployment.

Four of 10 inmates released from prison recidivate and are ‘reincarcerated’ within three years. Prison life may provide improved social situations and a rehabilitating environment, yet corrections often fall short of meeting acceptable standards of healthcare. Nonetheless, this article provides a brief overview of healthcare in the corrections environment and discusses factors that affect mental healthcare in prisons, similar to characteristics of the prison population and social policy. Mental illness is disproportionately represented within this system where half of all incarcerated individuals have a mental illness, compared to 11 of the population. Make sure you leave a comment about it in the comment section. Has a 15 year old daughter, he was never married. He was diagnosed with schizoaffective disorder and antisocial personality disorder, Inmate X is a ’49yearold’ Caucasian male who was first seen for mental health concerns at age 26 while incarcerated.

Inmate X was born to working class parents and grew up with two younger brothers, a twin sister and an older sister.

He sustained many additional probation violation charges for drug use, violation of restraining orders, and shoplifting, inmate X’s original offense was rape and burglary.

Records indicate So there’s no family history of drug/alcohol abuse or mental illness. Therefore, he has admitted to abusing alcohol, marijuana, cocaine and hallucinogens, inmate X has an extensive substance abuse history beginning at the age of 11. Inmate X graduated high school, worked a couple of jobs, and in addition served briefly in the United States Navy until his less than honorable discharge. Inmate X picked up an additional charge for mailing threatening letters to the United States President, while incarcerated. On top of that, upon inmate X’s risk panel assessment he was deemed to no longer be a risk to society and was released from prison. Inmate X had been stabilized on Olanzapine, Fluphenazine Deconate, Cogentin and Clonazepam, since his incarceration. Inmate X was transferred to an open mental health unit and had been a stellar resident indicated by job performance, medication compliance, group attendance and cooperation with other peers. Shortly thereafter, inmate X has again been stabilized on medications and as pointed out by his reviewing treatment team, inmate X appears to be upholding qualities deeming him appropriate for society.

The foregoing inmate’s story is one the inundated reflection prison system.

The United Kingdom has an average of 152 per 100000 people incarcerated, higher than other European countries that have an average of 120.

25 of the world’s prisoners,. Now this equates to approximately 756 per 100000 people incarcerated in the United States, There are approximately 2 million pre trial and 6 million posttrial inmates in county, state, and federal prisons. Now regarding the aforementioned fact… Russia might be one industrialized country that is close to the incarceration rate with an average of 627 per 100000. For example, china, with a population four times the United States, has an average of 6 million prisoners. Today the prison system is viewed as both a necessity to keep the public safe and as a mode of punishment for crimes. Notice, in America, imprisonment was considered unusual in the start of the 18th century. Imprisonment comes at an average cost per inmate of $ 31286 per year. Medical care alone accounts for an estimated 12percentage of prison budgets, second only to security costs, that include employee salaries, insurance, and retirement costs.

Cost concerns are a pressing issue as accommodating the expanding inmate population results in increased individual taxes to fund the necessary budget.

The goal of these programs is for healthcare providers to ultimately contribute to the rehabilitation of inmates and thus reduce recidivism.

The World Health Organization used this basic right to establish a guide detailing conditions that governments must generate to promote optimum health for their peoples, specifically stating that healthcare in prisons must be improved to better serve inmates. Integration of structured programs to serve populations endemic to corrections, like persons with substance abuse problems as well as mental illness, is one bridge to provide quality healthcare. Now this right is the driving force behind establishing standards and protocols in the treatment of inmates. Plenty of people assert that the right to health is a fundamental human right, in which any person, regardless of legal status, is entitled to receive adequate healthcare.

Both the and face limitations in prison settings.

Identical services provided in the community may not be acceptable levels of care for the complexity of psychiatric cases present within the prison system.

Healthcare providers are often restricted by policies and security protocols that limit interventions they may prescribe. Rates of mental illness and the lack of a clear legal framework for treating inmates with severe mental illness are other challenges to implementing the equivalence model. As a result, these limitations and restrictions suggest a great need for improvement in prison mental healthcare. I know that the supply of resources and treatment facilities is continuously challenged with the high demand and overcrowding of prison systems. Here they are screened by a few different disciplines including nursing, psychology, and an unit counselor. Consequently, during this intake screening with the nurse, an inmate’s medications are initially ordered. Inmate patients are also required to be seen by psychiatry services within 24 hours. Let me tell you something. For these medications, an alternative medication can be prescribed as an equivalent or the medication may be continued through a pharmacy non formulary request process. Loads of info can be found easily online. All inmate patients arrive at the prison in Receiving Discharge.

Like other facilities, however, So there’re medications that require non formulary requests, Most medications are continued.

Following the initial intake, a patient designated to be on an inpatient unit must have a physical completed within 24 hours by a mid level practitioner/provider.

The nurse reviews the medications and receives a verbal/telephone physician order to continue any medication for the inmate throughout the period of incarceration. Of course as well as inmates designated to a general population housing unit, inpatient inmates must be followed up by a physician for a physical within 14 days. Let me tell you something. When oral medications are distributed, the inmate will receive that medication throughout the next designated pill line time.

There’re predetermined times for meals as well as medications, including insulin lines.

Medications are typically given on time.

Inmates prescribed insulin and identical medications arrive at three separate, predetermined, designated times for pill line and insulin line to receive these medications. Exceptions to this may include. These exceptions typically cause a delay of less than 15 minutes. Other items that are locked and must be inventoried daily are. Rather more about each day nursing supplies being locked up or a need for additional prudence when accounting for items, challenges are not typically a matter of lacking supplies, as one might imagine. Many of us are aware that there are designated times for procedures just like dressing changes and intravenous and identical injections. Of course, all items pens) have to be counted and withdrawn from a medication dispensing machine. However, similar processes are in place for nursing treatments. As a result, genetic vulnerabilities are hypothesized as a reason for continued use as well.

In the short term, individuals may find they can reduce their degree of anxiety or depression by ‘self medicating’.

These statistics beg the question.

Continued use has often been attributed to a misguided attempt to treat symptoms of their mental illness. Genetic factors predispose individuals to both mental disorders and addictions, or to having a greater risk of the second disorder once the first appears. Selfmedicating’ and social factors are viewed as common contributors to substance abuse amongst mentally ill individuals. Therefore, individuals with mental illness may begin to use drugs or alcohol for recreational use, like their healthy counterparts. Individuals who have difficulty developing social relationships, often as a consequence of mental illness, find themselves more easily accepted by groups whose social activities is on the basis of drug use. Now let me tell you something. Mentally ill persons are often socially disenfranchised. Some reckon that an identity on the basis of drug addictions is more acceptable than one depending on mental illness. Research has also demonstrated that mentally ill individuals have quite a few chances to have a history of victimization. Poverty situates them to live in neighborhoods endemic with illicit substances, unemployment, and similar marginalized citizens. Although, other factors contribute to substance abuse in this population.

It’s nave to discount the evidence and won’t be able to address both problems of substance use and mental illness when addressing mental health concerns and care for prisoners, with the commonality of dual diagnoses.

In addition to those implicated in the stress response, brain circuits linked to reward processing, are affected by substance abuse and on top of that abnormalities in specific mental disorders. Isn’t available in each setting, federal prisons have even banned tobacco products since Mental health treatment can kind of separation from general population used when the presence of an individual poses a serious threat to the security of the institution. That said, this housing status includes inmates who, a) require protective custody, b) can not be placed all in all population being that they are pending travel to another institution, or c) those awaiting a hearing for a disciplinary violation. Being confined to a single area for agesed term tend to be psychologically harmful. So this may translate to bizarre, annoying, or dangerous behaviors. These effects are especially significant for individuals with mental illness. Then the nature and severity of the effects is dependent on the individual, length of stay, and conditions. Psychological effects can include anxiety, depression, anger, cognitive disturbances, perceptual disturbances, obsessive thoughts, paranoia, and psychosis. Therefore the lack of social contact, unstructured days, and stress can exacerbate psychiatric symptoms or provoke recurrence. Certainly, individuals with mental illness often have an impaired ability to cope with stress for a reason of their illness.

Within corrections, suicide profiles, depending on research studies, are used to target ‘highrisk’ individuals.

Pre trial inmates are generally male, young, unmarried, and arrested for minor, often substance related.

These suicides are often precipitated by a conflict, either within the prison, marital, or denial of parole, Another high profile group is sentenced individuals who are violent offenders, aged 30 35″ who have served an ideal interval of their sentence. Extended length of incarceration presents a brand new set of stressors, like victimization, loss of family support, fear of the unknown, embarrassment, and internal conflicts. Furthermore, this profiled group is at high risk during their first few hours of incarceration and near the time of a court hearing, especially when a guilty verdict and harsh sentencing is anticipated.

Given the high rates of substance abusers among the incarcerated population, misuse of prescription medications is a consideration amongst correctional providers. Medications might be used recreationally to achieve an altered mental state or high, instead of the intended therapeutic effect, as in the community. So that’s often preferred by inmates with a prior history of for ages because being since the similar effects it creates. Actually, misuse of anticholinergic agents is well documented in the literature. Quetiapine, referred to as quell, susie Q, or baby heroin is used in its powder form for its potent sedative and anxiolytic properties. Gabapentin is known to create an altered mental state or high from snorting the gabapentin powder. Wellbutrin, nicknamed welbys, is used intranasally to achieve a rush.

Other psychotropics similar to Olanzapine and tricyclic antidepressants are abused for sedative properties, mind altering effects, or the potential to get a high.

Abuse of other psychotropic medications is a growing concern in corrections.

Sedation, TCAs are lethal when hoarded and taken as an overdose. Consequently, quetiapine has become increasingly popular amongst incarcerated individuals. Remember, it necessitates additional paperwork for providers to support its use, when a medication is considered non formulary. Actually, abuse of on the basis of the prison environment alone. It could worsen and inmate’s mental and physical health. Criminalization of mental illness refers to the belief that if the mentally ill that are incarcerated had received the psychiatric services they needed, they should not be in trouble with the law. We see that individuals with mental illness are disproportionately represented in corrections and more gonna fail under correctional supervision, when the above-mentioned statistics are considered in context. However, these facts suggest that the mental health community has failed these individuals or that the perceived root of the trouble is criminalization of mental illness.

Perception of this criminalization as the sole problem has guided the corrections industry to the most logical solution.

These results suggest that the criminalization hypothesis shouldn’t be completely discarded.

In support of the criminalization hypothesis, one 113 study jail arrestees with a dual diagnosis of a psychiatric disorder and substance abuse disorder concluded that approximately 8percentage of their study population had been arrested as a direct or indirect result of their psychiatric symptoms. Certainly, the fact that the strongest predictors of violence and crime are identical for offenders with and without mental illness, and there being a typical third variable of increased social risk factor leading to crime, suggests an alternate hypothesis.

Besides, the hypothesis does not fully account for the link between mental illness and crime.

Mentally ill prisoners had higher recidivism rates or were more going to reoffend.

As already mentioned previously, in support of this social hypothesis results showed that major predictors of recidivism were quite similar for mentally disordered and for non disordered individuals. Mental illness was not an indicator of violence, studies found that illicit substance abuse was the strongest risk factor for violence. That’s interesting right? The social hypothesis suggests so it’s for ages being that, statistically, these prisoners have more risk factors than their healthy counterparts. Ok, and now one of the most important parts. Basically the strongest predictors of recidivism were prior history, employment problems, and antisocial personality. Consequently, further supporting the potential impact of lifestyle choices on recidivism was the finding that psychiatric symptoms have not demonstrated strong correlations with repeat arrests. Structured programs similar to education, vocational training, institutional jobs, substance abuse treatment, parenting, anger management, counseling, recreation, ‘faith based’ offerings, and similar programs teach inmates essential skills necessary for successful community reintegration. It’s a responsibility of the Bureau to provide inmates with skills needed to lead crimefree lives after release. Loads of information can be found by going online. The Bureau of Prisons philosophy is that preparation for release begins the first day of imprisonment.

Basically the goal of inmate programs is to assist in rehabilitating convicted felons into ‘law abiding’ citizens to decrease rising costs associated with recidivism.

Surely it’s likely that these programs must be beneficial as research has demonstrated that reasons for recidivism were similar among general population and mentally ill inmates.

These programs do not typically enroll a high population of mentally ill inmates. Known research has demonstrated that these programs play a major role to improve public safety. Now please pay attention. Of note, inmates enrolled in the Bureau’s Federal Prison Industries program, where inmates are employed in factories and are compensated, has significantly reduced recidivism in comparison to study control group members, demonstrated that inmates will be employed during their first year after release, and demonstrated that the inmates earn higher per average wages than counterparts not enrolled in the program. Basically, those enrolled in the residential drug abuse treatment programs were significantly less going to recidivate or relapse to drug use for at least three years as compared to similar nonparticipating inmates. Inmates enrolled in education programs demonstrated a significant decline in recidivism rates.

Health providers need to educate the public about mental illness generally, and in this population, to address mental health concerns for prisoners.

For inmates with mental health concerns, parole officers assume a role similar to that of a hospital case manager.

Parole officers should receive specified training about mental illness to support their efforts as a resource to avoid recidivism in released prisoners. Parole officers are often inundated with inmate caseloads beyond what they can handle. These officers should likely benefit from smaller caseloads with time assist parolees to access appropriate services, similar to day programs and home services. Healthcare providers can and must continue to educate the public to reduce the stigma of mental illness. Mental health concerns and high recidivism is a selfmade public health cr that can be transformed.

Eliminating social risk factors that may contribute to both the primary incarceration and recidivism, despite correctional challenges. Employment.a controlled environment inhibiting substance use while behind bars.

She is currently awaiting new orders from the USPHS to continue her work serving the underserved, incarcerated, mentally ill population as a PMHNPBC within the Bureau.

This professional experience and interaction with the mentally ill inspired Samantha to achieve her Master of Science in Nursing in Psychiatric/Mental Health. Furthermore, samantha Hoke completed her Bachelor of Science in Nursing from Worcester State College in Worcester, MA in spring Samantha became a commissioned corps nurse officer in the United States Public Health Service where she was and currently is stationed with the Department of Justice Federal Bureau of Prisons in Devens. It was here that Samantha worked as a lead nurse on the mental health units. Samantha completed her MSN in Spring 2014 and became board certified and licensed as a PMHNP.